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Volume XX |
Number 1 |
March 2007 |
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SUMMARIES
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BURNS AT THE SOROKA UNIVERSITY MEDICAL CENTER - A TWO-YEAR EXPERIENCE
(Gurfinkel R., Cohen A.D., Glezinger R., Krieger Y., Yancolevich N., Rosenberg L. - Israel)
Background. Burn trauma is a major public health concern, with increased risk for burns in children. Objectives. To characterize the profile of injured burn patients and to identify patients who are prone to burn injury. Methods. This is a cross-sectional study including all patients who were admitted to the Burns and Plastic Surgery Department, Soroka University Medical Center, Israel, between 1 January 2001 and 31 December 2002. Results. Five hundred and fifty-eight patients with a mean age of 15.4 yr (SD, 19.5 yr) were included in the study. There were 348 male patients (62.4%). The cause of the burns was scalding in 314 patients (56.3%), flame in 177 (31.7%), chemicals in 31 (5.6%), explosion in 20 (3.6%), and electricity in four (0.7%). There were 325 Bedouin patients (58.2%) and 221 Jewish patients (39.6%). In Bedouins, 235 patients (72.3%) were children below 5 yr, compared to 59 Jewish patients (26.7%) (p < 0.001). Eighteen burn patients (3.2%) expired. A multivariate analysis demonstrated that age and percentage of body surface area involved in the burn were significantly associated with mortality. Conclusions. The epidemiological characteristics of the burned population in Soroka University Medical Center are described. Burn injury has become a principal public health problem, particularly in Bedouin children. |
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EXPERIENCE OF BURN INJURIES AT THE PAKISTAN INSTITUTE OF MEDICAL SCIENCE, ISLAMABAD, PAKISTAN
(Ahmad M., Shahid Hussain S., Ibrahim Khan M., Malik S.A. - Pakistan)
The objective of this prospective study was to consider the demographical data of burn patients admitted to the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The study was carried out at PIMS from January 2002 to December 2003. Only admitted patients of either sex of age more than 12 yr were included. Patients below 12 yr were excluded. Patients requiring outpatient treatment were also excluded. A total number of 77 males and 65 females fulfilled the criteria. The mean age of the males was 32.2 yr and of the females 24.4 yr, while the male/female ratio was 1/1.18. Burns were commonest during the winter season (42.2%). In 6% of the patients, the burns were due to suicide attempts and in 15% to homicidal intent. The burns were accidental in 79% of cases. The major mechanism in females was stove burst (22%) and in males direct flame (18%). The kitchen was the commonest site of the accident in females (27%). Housewives were the most frequently affected (35%). More married males (39%) were burned than unmarried females (18%). Inhalational injury was present in 23% of the patients. Males had average total body surface area burned of 27.4% compared with 39.5% in females. Eighteen per cent of the deaths occurred among males and 16% among females. This study provides a comprehensive overview of hospitalized burn patients in Pakistan. Prevention is always the rule to be safe from burns but, once they occur, immediate and proper care should be given with aggressive treatment in order to minimize post-burn problems. |
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A STUDY OF BURNS IN CHILDREN
(Subrahmanyam M. - India)
A retrospective study was made of burns in children admitted to a burns centre in India over a 5-yr period (1999-2003). Of the total number of 2364 burn patients admitted during this period, 222 were children (9.4%). Of these, 134 cases whose records were available were analysed for age, sex, site of injury, causes, place of accident, mortality, etc.: 131 out of the 134 cases were accidental, two suicidal, and one homicidal. Scalds are commonest (65 cases = 49%), followed by flames. Forty-seven children died (35.1%) and 65 survived (48.5%); there were 22 cases of self-discharge. Mortality was directly proportional to percentage TBSA burn: of the 28 patients with more than 50% TBSA burns, 26 (92.8%) died. |
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SEQUELLES DE BRULURES AU CENTRE HOSPITALIER UNIVERSITAIRE IBN ROCHD DE CASABLANCA: ASPECTS EPIDEMIO-CLINIQUES
(Chafiki N., Fassi Fihri J., Boukind E.H.. - Maroc)
Il s'agit d'une étude épidémiologique des séquelles de brûlures à propos de 100 cas colligés au service de chirurgie réparatrice et de brûlés du centre hospitalier universitaire Ibn Rochd (Casablanca). Les adultes représentent 55% de la population étudiée, l'âge moyen global est de 20 ans. Le sexe féminin est le plus touché avec 61% des cas. Les brûlures survenues à domicile sont les plus fréquentes avec 80%. L'agent causal le plus incriminé est la petite bouteille de butane avec 44,4%. Plus de la moitié de la population brûlée (55%) sont accueillis initialement au niveau d'hôpitaux régionaux. Le délai de cicatrisation moyen de 7 mois et 11 jours et par conséquent les séquelles mineures (dyschromie dans 90% des cas et prurit dans 49% des cas) et majeures (rétractions dans 86% et l'hypertrophie dans 51%) sont fréquentes. La répartition globale des séquelles montre une prédominance du segment cervicocéphalique avec 89% des cas et des membres supérieurs dans 82% des cas. Les différents aspects anatomocliniques essentiels ont été décrits au niveau de chaque segment corporel. Nos résultats ont été comparés aux données de la littérature, ce qui nous amène à considérer qu'une large campagne de prévention couplée à une meilleure prise en charge initiale, précoce, bien conduite et multidisciplinaire permet non seulement de réduire le nombre de séquelles mais aussi de diminuer leur sévérité. |
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THE POLICY OF OUR CLINIC IN EARLY ESCHARECTOMY IN BURNS OF THE HAND
(Zeniou A., Ioannou A., Protopapa A., Kotsakis I., Yiallouros C., Koulermou G. - Cyprus)
Early escharectomy in deep partial- and full-thickness burns of the hand has proved to have an advantage over late surgical treatment. It provides an improved functional and cosmetic result. Hand deformities, the need for secondary reconstructive procedures, and morbidity are significantly reduced. In our clinic we prefer to use early escharectomy in all full-thickness burns of the hand unless the patient's condition prevents it or unless the extent of the burns in the rest of the body would prevent improvement in the general outcome. |
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THE USE OF ESMARCH EXSANGUINATION FOR THE TREATMENT OF EXTREMITY WOUND BURNS
(Aballay A.M., Recio P., Slater H., Goldfarb I.W., Tolchin E., Papasavas P., Caushaj P.F. - USA)
Tourniquets are routinely used during the excising and grafting of burn wounds located on the limbs in order to decrease blood loss. It has been postulated that the exsanguination of extremities by using Esmarch bandages might further reduce blood loss. However, there are concerns about a decrease in graft quality when Esmarch bandages are applied. The purpose of this prospective, double-blinded randomized study was to compare Esmarch application in addition to tourniquet (exsanguinated extremities) with the application of tourniquet alone. Thirty-eight excisions of bilateral extremity wounds were performed. Both limbs were tangentially excised after tourniquet application with one limb randomly chosen for prior Esmarch exsanguination. Blood loss was estimated during this procedure. Graft take was assessed twice: on post-operative days 3 and 7. The burn surface area and total area grafted were equivalent in the extremities with Esmarch bandages when compared to the extremities without them. Total blood loss was less in the extremities where Esmarch was applied. Graft take was similar in the two groups. Statistical analysis was performed with a two-tailed paired T-test. It is concluded that the use of Esmarch exsanguination in addition to tourniquet further reduces blood loss without affecting the quality of the engraftment. |
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NUTRITIONAL INTERVENTIONS IN SEVERE BURNS IN CHILDREN - THERAPEUTIC RESULTS
(Spodaryk M.1, Pucha J. - Poland)
This paper, which supplements the theoretical articles already published in Annals of Burns and Fire Disasters (vol. XVIII, pp. 117-21, 2005), presents the therapeutic results achieved in 37 extremely burned paediatric patients. The clinical analysis included nutritional protocols and methods of monitoring treatment effectiveness. The necessity of introducing nutritional intervention immediately after initiation of severe burns treatment is unquestionable, the aim being to decrease catabolism in the initial period of the burn disease followed by the achievement of the appropriate metabolic determinants of wound healing. |
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HEPARIN REDUCED MORTALITY AND SEPSIS IN SEVERELY BURNED CHILDREN
(Zayas G.J., Bonilla A.M., Saliba M.J. - Canada)
Objectives. In El Salvador, before 1999, morbidity and mortality in severely burned children were high. In 1998, all children with burns of 40% or larger size died and sepsis was found. With heparin use in 1999, some similarly burned children survived, and sepsis, pain, procedures, and scars were noted to be less. This retrospective study presents the details. Methods. A study was conducted at the National Children's Hospital in El Salvador of all children with burns over 20% size treated in 1998, when no heparin was used, and in 1999, when heparin was added to burns treatment, using an ethics committee approved protocol in use in twelve other countries. Sodium aqueous heparin solution USP from an intestinal source was infused intravenously and applied topically onto burn surfaces and within blisters for the first 1-3 days post-burn. Then heparin, in diminishing doses, was continued only topically until healing. The treatments in 1998 and 1999 were otherwise the same, except that fewer procedures were needed in 1999. Results. There were no significant differences in gender, age, weight, burn aetiology, or burn size between the burned children in 1998 and those in 1999. Burn pain was relieved and pain medicine was not needed in children treated with heparin in 1999. In 1998, one child survived who had a 35% size burn, and the eight children died who had burns of 40% and over. The survival rate was one out of nine (11%). The average burn size was 51.7%. With heparin use in 1999, six of the ten children survived burns of 50.7% average size. The increase in survival with heparin from 11% to 60% and, therefore, the decrease in mortality from 89% to 40% were significant (p < 0.04). Clinical symptoms and positive blood cultures documented bacterial sepsis in the nine children in 1998. In 1999, the blood cultures for sepsis were positive in the four children who died and negative in the six who survived. The nine versus four differences in the incidence of sepsis between 1998 and 1999 was significant (p < 0.008). The survivors had notably smooth skin. Conclusions. The use of heparin in this study relieved burn pain, significantly reduced mortality and sepsis with fewer procedures, and discernibly improved cosmetic results. |
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THIRD REFINEMENT IN RHOMBOID RELEASE OF CONTRACTURES BY ADDING FOUR-FLAP Z-PLASTIES
(F¦nd¦k H., Eroglu Ciloglu N.S., Uzunismail A. - Turkey)
Rhomboid release has been utilized in the reconstruction of flexion contractures. In this study a new refinement of the rhomboid subcutaneous flap with a combination of adjacent four-flap Z-plasties on both sides is presented. Satisfying functional results were obtained, keeping the rhomboid flap and the structures on the rhomboid flap in their original position. The new design of the previous rhomboid release - the "rhomboid flap and adjacent four-flap Z-plasties" - makes it possible to preserve important anatomical landmarks, such as hairy skin in the axilla, the nipple/areola complex, and the pubic area in the contracture, and is considered a good method of releasing burn or congenital contractures. |
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IN VITRO ANTI-STAPHYLOCOCCAL ACTIVITY OF HONEY AND TWO STANDARD ANTIBIOTICS (CLOXACILLIN AND AMPICILLIN
(Adeleke O.E.1, Anyacho C.E.2, Onakoya T.M. - Nigerie)
Fifty bacterial isolates comprising Staphylococcus aureus and Staphylococcus albus from six pathological sources were exposed to honey and its fractional dilutions as also as to two standard antibiotics - cloxacillin (5 mg/ml) and ampicillin (10 mg/ml) - in an agar-cup diffusion sensitivity test. The undiluted honey showed antibacterial activity against almost 100% of the bacterial isolates while its 1:2 to 1:10 fractional dilutions also had antibacterial property against the isolates in decreasing order of activity. Cloxacillin recorded higher antibacterial activity than ampicillin but both exerted less antibacterial activity than honey. The therapeutic application of honey, following clinical trials, should be of relevance in treating bacterial infections and, in particular, those due to the two Staphylococcus species tested. |
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Case report: ELECTRICAL BURNS
(Belba G., Isaraj S., Kola N., Xhepa G., Belba M., Aleksi A. - Albania)
A brief description is given of a case involving a man suffering from deep injuries due to the passage of electric current in both arms. Through this description we wish to demonstrate our strategy for the selection of the most appropriate surgical techniques, illustrating this with relevant photos. The formation of thrombi in the brachial arteries obliged us to proceed to bilateral amputation at the level of the forearms. Even though this patient now has no hands, he made a full recovery and leads a normal life. |
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